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General NPI Number Information
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NPI Number | 1932628518
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Entity Type | Organization
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Legal Business Name | RESTORING WELLNESS COUNSELING
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Dates
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Enumeration Date | 09/14/2017
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Last Update Date | 09/14/2017
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Provider Practice Location Address
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Address Line | 1226 ROYAL DR SW STE E
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City | CONYERS
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State | GA
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Zip | 30094-5926
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Country | US
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Telephone | 770-568-9089
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Fax | 770-568-9089
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Provider Business Mailing Address
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Address Line | 1623 CHERRY HILL CT SW
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City | CONYERS
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State | GA
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Zip | 30094-6273
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Country | US
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Telephone | 770-568-9089
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | MS. ROSE MARIE WILLIAMS
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Credential | LCSW
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Telephone | 770-568-9089
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW005212
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License Number State | GA
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